Comparison of myocardial damage among dogs at different stages of clinical leishmaniasis and dogs with idiopathic chronic kidney disease.

Canine leishmaniasis (CanL) is a systemic disease caused by the protozoan parasite Leishmania infantum. Myocarditis in CanL has been described previously in CanL by histopathological analysis of post-mortem specimens and by evaluation of cardiac troponin I (cTnI) levels. However, the degree of myocardial damage at different stages of CanL and the role that concurrent azotaemia plays in this myocardial injury are unknown. The aim of this study was to prospectively evaluate and compare the presence of myocardial injury in dogs at different stages of clinical CanL and in dogs with severe idiopathic chronic kidney disease (CKD) by measuring cTnI. Forty-eight dogs were included in the study, divided into four groups: (1) group A (10 healthy dogs); (2) group B (17 dogs with CanL without renal azotaemia, classified as mild to severe in the LeishVet scheme); (3) group C (11 dogs with CanL and renal azotaemia, classified as very severe in the LeishVet scheme); and (4) group D (10 dogs with idiopathic CKD). Dogs in group C had significantly higher cTnI than dogs in groups B and D, although cTnI was also elevated in these groups. Dogs in group A had normal cTnI values. Dogs in groups D and C had similar renal IRIS classification scorers. Severe lymphoplasmocytic myocarditis and a positive real time PCR of L. infantum DNA were observed in all dogs in group C. Dogs with very severe CanL exhibit more myocardial injury than dogs with milder CanL or dogs with idiopathic CKD.

Meningitis bacteriana aguda por S. pneumoniae / Acute bacterial meningitis due to S. pneumoniae

Resumen La meningitis bacteriana aguda es una enfermedad infecciosa, considerada una urgencia médica. La mortalidad secundaria alcanza hasta 37% y las secuelas neurológicas se estiman en 52% de los adultos supervivientes. El diagnóstico y tratamiento oportunos tiene una importante repercusión en la evolución de la enfermedad. Comunicamos el caso de un paciente de 33 años de edad, con antecedente de sinusitis crónica, sometido a tratamiento quirúrgico mediante rinoplastia electiva. En el periodo posquirúrgico inició con desorientación, agitación psicomotriz, fiebre, rigidez de la nuca y convulsiones tónico-clónicas generalizadas. Se realizó tomografía de cráneo, que reportó sinusitis etmoidal y esfenoidal. Ingresó a la unidad de cuidados intensivos debido a que requirió apoyo mecánico ventilatorio; recibió tratamiento empírico con esteroides, ceftriaxona y vancomicina. Se le realizó punción lumbar y el análisis del líquido cefalorraquídeo fue sugerente de infección piógena. El cultivo desarrolló Streptococcus pneumoniae sensible a penicilina, por lo que se ajustó el tratamiento antimicrobiano con penicilina G sódica cristalina. El paciente egresó 15 días después, sin secuelas neurológicas. En pacientes con factores de riesgo y un cuadro clínico sugerente de meningitis bacteriana debe iniciarse el tratamiento antibótico lo antes posible, con la finalidad de disminuir la mortalidad y las complicaciones asociadas.

Abstract Acute bacterial meningitis is considered a medical emergency. Mortality is up to 37% and the neurological sequels are estimated at 52% in the survivors. The timely management and diagnosis have a significant impact on the evolution of the disease. This paper reports the case of a 33-year-old male with a history of chronic sinusitis, he was summited to an elective rhinoplasty, and 24 hours after the surgery the patient began with disorientation, psychomotor agitation, fever, neck stiffness and generalized tonic-clonic seizures. Cranial CT showed ethmoidal and sphenoidal sinusitis. Lumbar puncture was done and the cerebrospinal fluid (CFS) analysis was suggestive of pyogenic infection. Patient was admitted to the intensive care unit (ICU) with mechanical ventilation. Empirical treatment with steroids, ceftriaxone and vancomycin was started. The cerebrospinal fluid culture revealed Streptococcus pneumoniae penicillin susceptible. Antimicrobial treatment was adjusted to penicillin G, and after 15 days patient was sent to home without any neurological damage. In patients with risk factors and a clinical picture suggestive of bacterial meningitis treatment should be started as soon as possible, with the aim of reducing the mortality and the associated complications.

Long-memory and the sea level-temperature relationship: a fractional cointegration approach.

Through thermal expansion of oceans and melting of land-based ice, global warming is very likely contributing to the sea level rise observed during the 20th century. The amount by which further increases in global average temperature could affect sea level is only known with large uncertainties due to the limited capacity of physics-based models to predict sea levels from global surface temperatures. Semi-empirical approaches have been implemented to estimate the statistical relationship between these two variables providing an alternative measure on which to base potentially disrupting impacts on coastal communities and ecosystems. However, only a few of these semi-empirical applications had addressed the spurious inference that is likely to be drawn when one nonstationary process is regressed on another. Furthermore, it has been shown that spurious effects are not eliminated by stationary processes when these possess strong long memory. Our results indicate that both global temperature and sea level indeed present the characteristics of long memory processes. Nevertheless, we find that these variables are fractionally cointegrated when sea-ice extent is incorporated as an instrumental variable for temperature which in our estimations has a statistically significant positive impact on global sea level.